‘You are old, Father William,’ the young man said, ‘and your hair has become very white; And yet you incessantly stand on your head – Do you think, at your age, it is right?’
LEWIS CARROLL
How fit and active are you? Do you play badminton and go to the gym every week? And when did you last skydive for charity? One remarkable 90-year-old from Eastbourne in Sussex, does all of the above. She is one of the growing band of ‘old old’, or the fourth generation, as they are now called. Another example is an amazing lady in Bangor who has just turned 106. She says the key to her long and healthy life is not worrying about anything. She lived independently in her own home well into her late 90s. She remains sharp, walks unaided and entertains other residents in her nursing home with piano playing. With more than 1.5 million over-85s in the UK, and this number set to double by 2030, the demography of this country is changing dramatically. But it is wrong to assume that the ageing population are all likely to become a burden. Many of the elderly, given a bit of support in the community, stand a good chance of remaining independent for a long time. Old age may bring its challenges, but it does not necessarily spell a downward spiral to infirmity. The majority of people in their late 80s rate their health and quality of life as good, but there are two key factors: remaining active and maintaining friendships (Source: www.bbc.co.uk/news/health-21757212).
With such an overwhelming amount of information available these days on how to live well and what to do to ensure a safe, healthy and happy old age, is growing old getting easier? Much of the advice is based on sound evidence, but there is a lot that is confusing and contradictory: what seems good for people one day can all too often be reported as being bad for them the next. If you are one of the many recently retireds who cares about, or actively cares for, ageing parents, working out how best to help them enjoy their final years can be a daunting task. There is a wealth of suggestions, active campaigns, products, training and research being carried out, making it almost impossible to keep track. One of the more recent projects is by Age UK’s Research into Ageing Fund (RiAF). Here scientists are working to help alleviate memory loss, restore speech after a stroke, improve muscle strength to prevent falls and much more. Their excellent booklet, Improving Later Life, is well worth reading. For more information and to obtain a copy, see Age UK’s website: www.ageuk.org.uk/improvinglaterlifebook.
The most often expressed wish by elderly people is that they remain independent and able to live in their own home for as long as possible. With a bit of support from friends, relatives or local care organizations, many should be able to do this. Should you become responsible for looking after elderly, frail or disabled relatives, you are not alone. There are more than 6.4 million carers in the UK, with 2 million taking up the role every year. Carers save the economy a staggering £119 billion each year, an average of £18,473 each (source: Carers UK: www.carersuk.org). One thing that is vital as people get older is remaining positive about their physical health, because it is good for their mental health as well. According to recent research, genetics accounts only for about a quarter of what determines the length of life. This means that three-quarters of how well people age is dictated by factors that are within each individual’s control, such as nutrition and lifestyle. If you are keen to help your parent, relative or friend remain well and happy for as long as possible, read on:
Ten top tips for healthy ageing (from RiAF):
The main focus of this chapter is on helping the elderly remain as independent as possible, for as long as possible, until a care home or nursing home becomes necessary. Knowing what facilities are available and what precautions your parents can take against a mishap occurring is an important factor. Being aware of whom they can turn to in an emergency can make all the difference. There is now much greater awareness of the needs of the elderly, mostly in regard to the financial implications of funding older people’s care. In line with this, many provisions for the elderly have improved enormously. It is possible to find out from your local authority what programmes operate in your area that can help. Ask your parents’ GP where to start, such as obtaining an assessment from Adult Social Services.
It is well worth investing a bit of time finding out where help and support can be accessed and familiarizing yourself (on your parents’ behalf) with how to source funding or access equipment and personal aids. A bit of time spent improving their home to make it easier to cope as they get older, and fine-tuning their social and support network, should make all the difference and help them maintain their independence for longer. Here’s one interesting and simple example: for the last 12 years a successful campaign, Spring Online, delivered by Digital Unite, has helped older people combat the effects of ‘digital exclusion’. More than 7 million people in the UK have never used the internet – 6.3 million of them aged over 55. There have been many success stories, including a 100-year-old woman who asked for a laptop for her birthday present, and a recovering stroke victim who learned to access online banking and shopping, making a huge difference to his quality of life. (For more information see: www.digitalunite.)
Many families face the difficult choice between moving parents in with them or allowing them to continue to live on their own. While the decision will depend on individual circumstances, if safe to do so ‘staying put’ is usually preferable. In order to avoid moving, the best solution for most elderly people is to adapt their home to make it safer and more convenient.
Many elderly people will not require anything more complicated than a few general improvements. These could include better lighting, especially near staircases, a non-slip mat and grab rails in the bathroom, and safer heating arrangements. For some, a practical improvement might be to lower kitchen and other units, to place them within easy reach to make cooking less hazardous. Another fairly simple option is to convert a downstairs room into a bedroom and en suite bath or shower, should managing the stairs be proving difficult. These and other common-sense measures are covered in more detail in Chapter 8, Your home. Should such arrangements not really be sufficient, in the case of a physically handicapped or disabled person, more radical changes will usually be needed. This involves accessing help from the GP and local authority.
Local authority help
The state system is designed to support the elderly in their own home for as long as possible. Local authorities have a legal duty to help people with disabilities and, depending on what is required and the individual’s ability to pay, may assist with the cost. Best advice is to approach their GP or contact the social services department direct. A sympathetic doctor will be crucial support at this stage, particularly if he or she has known them for some years and is familiar with their circumstances. The GP will be able to advise what is needed and supply any prescriptions, such as for a medical hoist, and will also be able to suggest which unit or department to approach, and make a recommendation to the housing department, should re-housing be desirable. If your parents can afford it, they will have to pay for the services they need themselves. If their income and savings are low, the council may pay part or all of the cost.
Local authority services
Social services departments (social work departments in Scotland) provide many of the services that people with disabilities may need, including:
In most instances, you should speak to the social worker allocated to look after your elderly relatives, who will either be able to make the arrangements or point you in the right direction. He or she will also be able to tell you of any special facilities or other help provided by the authority.
Health care and specialist services
Local authorities employ a number of specialist helpers, variously based in the social services department or health centre, who are there to assist:
Council tax
If an elderly relative has a disability, they may be able to claim a reduction on their council tax. If they have a blue badge on their car, they may get a rebate for a garage. They should apply to the housing benefits officer, but different councils employ different officers to deal with this; see website: www.gov.uk – Disabled People.
Help with home repair and adaptations
Disabled facilities grant
This is a local council grant to help towards the cost of adapting a home to enable a disabled or elderly person to live there. It can cover a wide range of improvements to help the occupants manage more independently. This includes work to facilitate access either to the property itself or to the main rooms, the installation of ramps or a lift; the provision of suitable bathroom or kitchen facilities; and various other works which would make a home safe for a disabled person. Provided the applicant is eligible, currently a mandatory grant of up to £30,000 in England, £25,000 in Northern Ireland and £36,000 in Wales may be available. See website: www.gov.uk – Disabled People.
Home Improvement Agencies (HIAs)
Home Improvement Agencies assist vulnerable homeowners and private sector tenants who are older, disabled or on a low income to repair, improve, maintain or adapt their homes. They are local, not-for-profit organizations. There are approximately 200 home improvement agencies in England and around 85 per cent of residents in England have access to a home improvement agency. They are sometimes known as Care & Repair or Staying Put schemes. For HIAs in the UK, see:
Foundations: www.foundations.uk.com.
Care and Repair Cymru: www.careandrepair.org.uk.
Care and Repair Scotland: www.careandrepairscotland.co.uk.
Other organizations which can help include:
Age UK: www.ageuk.org.uk.
British Red Cross: www.redcross.org.uk.
Assist UK: www.assist-uk.org.
CAE (Centre for Accessible Environments): www.cae.org.uk.
DEMAND (Design & Manufacture for Disability): www.demand.org.uk.
Disability Wales/Anabledd Cymru: www.disabilitywales.org.
Disabled Living Foundation (DLF): www.dlf.org.uk.
Hearing and Mobility: www.hearingandmobility.co.uk.
REMAP: www.remap.org.uk.
Alarm systems for the elderly are many and varied, but the knowledge that help can be summoned quickly in the event of an emergency is reassuring in its own right to many elderly or disabled people. Having a personal alarm can enable many people to remain independent far longer than would otherwise be sensible. Some alarm systems allow people living in their own homes to be linked to a central control, or have a telephone link, enabling personal contact to be made. Others simply signal that something is wrong. Sometimes a relative or friend who has been nominated will be alerted. Your parents’ local authority social services department will have information. See website: www.gov.uk.
A number of organizations offer alarm systems, medical alerts and other devices. Some useful websites include:
DLF (Disabled Living Foundation): www.dlf.org.uk.
Contact4me: www.contact4me.com.
Helpline Limited: www.helpline.co.uk.
MedicAlertUK: www.medicalert.org.uk.
Community alarms
Telephone alarm systems operated on the public telephone network can be used by anyone with a direct telephone line. The systems link into a 24-hour monitoring centre and the individual has a pendant that enables help to be called even when the owner is some distance from the telephone. Grants may be available in some cases to meet the costs.
Age UK Personal Alarm Service: www.ageuk.org.uk.
SeniorLinkEldercare: www.seniorlinkeldercare.com.
Quite apart from any assistance with housing, local authorities supply a number of services that can prove invaluable to elderly people. The two most important are meals on wheels and home helps. Additionally, there are social workers and various specialists concerned with aspects of health care (already mentioned above). Since the introduction of Community Care, local authority social services departments have taken over all responsibility for helping to assess and coordinate the best arrangements for individuals according to their particular requirements. Other organizations which may offer home help include the British Red Cross and Age UK (websites already listed above).
Meals on wheels
The meals on wheels service is sometimes run by local authorities direct and sometimes by voluntary organizations, such as WRVS, acting as their agents. The purpose is to deliver ready-made meals to individuals in their own homes. Different arrangements apply in different areas, and schemes variously operate from two to seven days a week, or possibly less frequently if frozen meals are supplied. For further information, contact the local social services department or see website: www.gov.uk – Meals at home services. The other organization which delivers over 6 million meals a year to people who have difficulty with shopping, carrying food home or cooking for themselves is WRVS: www.wrvs.org.uk.
Local authorities have a legal obligation to run a home-help service to help frail and housebound elderly people with such basic household chores as shopping, tidying up, a little light cooking and so on. In many areas the service is badly overstretched, so the amount of help actually available varies considerably, as does the method of charging. A health and social care assessment with the social services department of your local council is often the first step towards getting the help and support your parents need. See website: www.gov.uk – Disabled people.
Good neighbour schemes
A number of areas of the country have an organized system of good neighbour schemes. In essence, these consist of volunteers agreeing to act as good neighbours to one or several elderly people living close by. Depending on what is required, they may simply pop in on a daily basis to check that everything is all right, or they may give more sustained assistance such as providing help with dressing, bathing, shopping or preparing a light meal. To find out whether such a scheme exists locally, ask the local authority, social services, your parents’ health centre, or the Citizens Advice Bureau.
Voluntary organizations complement the services provided by statutory health and social services in making life easier for elderly people living at home. The range of provision varies from area to area but can include:
The particular organization providing these services depends on where your parents live, but the best place to get advice is the local Citizens Advice Bureau. These are the key agencies:
Age UK: www.ageuk.org.uk.
Age Scotland: www.ageuk.org.uk/scotland.
Age Wales: www.ageuk.org.uk/cymru.
Age Northern Ireland: www.ageuk.org.uk/northern-ireland.
Disability Wales: www.disabilitywales.org.
Update (Scotland’s disability information service): www.update.org.uk.
Care Information Scotland: www.careinfoscotland.co.uk.
Centre for Individual Living, Northern Ireland: www.cilbelfast.org.
British Red Cross: www.redcross.org.uk.
St John Ambulance: www.sja.org.uk.
WRVS: www.wrvs.org.uk.
Other sources of help and advice include:
Civil Service Retirement Fellowship: www.csrf.org.uk.
Disability Rights UK: www.disabilityrightsuk.org.
Jewish Care: www.jewishcare.org.
National Brokerage Network: www.nationalbrokeragenetwork.org.uk.
Difficulty in getting around is often a major problem for elderly and disabled people. In addition to the facilities run by voluntary organizations already mentioned, there are several other very useful services:
Forum of Mobility Centres: www.mobility-centres.org.uk.
London Taxicard: www.londoncouncils.gov.uk/services/taxicard.
Motability: www.motability.co.uk.
Driving licence renewal at age 70
All drivers aged 70 are sent a licence renewal form to have their driving licence renewed. The entitlement to drive will need to be renewed by the DVLA; the new licence will normally be valid for three years. See website: www.gov.uk – Driving, Transport and Travel.
Many people in their late 70s and older travel across the world, go on activity holidays and see the great sights in the UK and abroad without any more difficulty than anyone else. They will find plenty of choice in Chapter 14, Holidays, including information about how to obtain assistance at airports and railway stations. However, some elderly people need special facilities if a stay away from home is to be possible. A number of organizations can help:
Able Travel: www.able-travel.com.
Accessible Travel and Leisure: www.accessibletravel.co.uk.
Can be done: www.canbedone.co.uk.
Chalfont Line: www.chalfont-line.co.uk.
Disability Holidays Guide.com: www.disabilityholidaysguide.com.
Enable holidays: www.enableholidays.com.
Tourism for All: www.tourismforall.org.uk.
Voluntary organizations
A number of the specialist voluntary organizations run holiday centres or provide specially adapted self-catering accommodation. In some cases, outings and entertainment are offered; in others, individuals plan their own activities and amusement. Guests requiring assistance usually need to be accompanied by a companion, although in a few instances care arrangements are inclusive. Most of the organizations can advise about the possibility of obtaining a grant or other financial assistance.
Holidays for all: www.holidaysforall.org.uk.
Holiday with Help: www.holidayswithhelp.org.uk.
Leonard Cheshire: www.leonard-cheshire.org.
Vitalise: www.vitalise.org.uk.
The Disabled Travellers’ Guide, published by the AA, lists a wide choice of holiday venues where disabled travellers can go in the normal way but with the advantage of having special facilities provided. Downloadable in pdf format, it gives information on holiday accommodation suitable for disabled individuals and their families, together with advice on travelling in Europe. See website: www.theaa.com.
Giving another person Power of Attorney authorizes someone else to take business and other financial decisions on the donor’s behalf. A Lasting Power of Attorney continues, regardless of any decline, throughout the individual’s life. To protect the donor and the nominated attorney, the law clearly lays down certain principles that must be observed, with both sides signing a declaration that they understand the various rights and duties involved. The law furthermore calls for the power to be formally registered with the Public Trust Office in the event of the donor being, or becoming, mentally incapable.
A Lasting Power of Attorney permits someone to be appointed to make decisions on behalf of another. It is normally used when someone is unable to make their own decision. There are two types: health and welfare; and property and financial affairs. One type of Lasting Power of Attorney can be made at a time, or it is possible to do both together.
The right time to arrange a Power of Attorney is while an individual is in full command of his or her faculties, so that potential situations that would require decisions can be properly discussed and the donor’s wishes made clear. For the Lasting Power of Attorney to be valid, the donor must in any event be capable of understanding what he or she is agreeing to at the time of making the power. If an elderly person you care about is considering setting up an LPA, it is advisable that they consult their GP and the family solicitor.
For further information see: www.gov.uk/power-of-attorney/ or www.justice.gov.uk/forms.
Temporary
Elderly people living alone can be more vulnerable to flu and other winter ailments; they may have a fall; or, for no apparent reason, they may go through a period of being forgetful and neglecting themselves. Equally, as they become older, they may not be able to cope as well with managing their homes or caring for themselves. In the event of an emergency or if you have reason for concern – perhaps because you are going on holiday and will not be around to keep a watchful eye on them – engaging living-in help can be a godsend. Most agencies tend inevitably to be on the expensive side, although in the event of a real problem they often represent excellent value for money. A more unusual and interesting longer-term possibility is to recruit the help of a Community Service Volunteer.
Community Service Volunteers (CSVs)
CSV is the UK’s leading training and volunteering charity, training over 12,000 young people and adults each year. They provide practical assistance in the home and also offer companionship. Usually a care scheme is set up through a social worker, who supervises how the arrangement is working out. Volunteers are placed on a one-month trial basis. For more information contact your parents’ local social services department, or see CSV: www.csv.org.uk.
Agencies
The agencies listed specialize in providing temporary help, rather than permanent staff. Fees are normally paid by private funding, but depending on individual circumstances, public financial assistance may be available.
Bunbury Care Agency: www.bunburyagency.com.
Consultus Care & Nursing Agency Ltd: www.consultuscare.com.
Country Cousins: www.country-cousins.co.uk.
Live-In Support: www.live-insupport.co.uk.
The Care Agency: www.thecareagency.co.uk.
For a further list of agencies, see The Lady magazine, or search the internet under the heading ‘Nursing agencies’ or ‘Care agencies’.
If one of your parents needs regular nursing care, the GP may be able to arrange for a community or district nurse to visit him or her at home. This will not be a sleeping-in arrangement but simply involves a qualified nurse calling round when necessary. If they need more concentrated home nursing you will have to go through a private agency. Some of those listed above can sometimes supply trained nurses. Additionally, there are many specialist agencies that can arrange hourly, daily or live-in nurses on a temporary or longer-term basis.
Fees and services vary considerably. Costs vary throughout the country, with London inevitably being most expensive. Private health insurance can sometimes be claimed against part of the cost, but this is generally only in respect of qualified nurses. Your local health centre or social services department should be able to give you names and addresses of local agencies, or search the internet under the heading ‘Nursing agencies’.
Permanent
There may come a time when you feel that it is no longer safe to allow one of your parents to live entirely on his or her own. One possibility is to engage a companion or housekeeper on a permanent basis. However, if you want to investigate the idea further, many domestic agencies supply housekeeper-companions. Alternatively, you could advertise in the most widely read publication for these kinds of posts. See The Lady Magazine: www.lady.co.uk.
Permanent help can also sometimes be provided by agencies, which will supply continuous four-weekly placements. This is an expensive option, and the lack of continuity can at times be distressing for elderly people, particularly at the changeover point. The agencies listed above may be worth contacting.
Au pairs are cheaper but a drawback is that most au pairs speak inadequate English (at least when they first arrive). As they are technically students living en famille, they must by law be given plenty of free time to attend school and study. For more information see: www.gov.uk/au-pairs-employment-law.
One of the problems for many elderly people is that the amount of care they need is liable to vary according to the state of their health. There are other relevant factors including, for example, the availability of neighbours and family. Whereas after an operation the requirement may be for someone with basic nursing skills, a few weeks later the only need may be for someone to act as a companion. Under normal circumstances it may be as little as simply popping in for the odd hour during the day to cook a hot meal and check all is well. Here are a few agencies that offer a flexible service:
Anchor Care: www.anchor.org.uk.
Christies Care: www.christiescare.com.
Cura Domi – Care at Home: www.curadomi.co.uk.
Miracle Workers: www.miracle-workers.co.uk.
UKHCA (United Kingdom Home Care Association): www.ukhca.co.uk.
Although any of these suggestions can work extremely well for a while, with many families it may sooner or later come down to a choice between residential care and inviting a parent to live with you. Sometimes, particularly in the case of an unmarried son or daughter or other relative, it is more practical to move into the parent’s (or relative’s) home if the accommodation is more suitable.
For many elderly people a pet is a very important part of their lives. It provides companionship and fun as well as stimulating them into taking regular outdoor exercise. Because pets usually have shorter life spans than us, some may have planned for this event. But what if your elderly loved ones become ill or incapacitated, or dies first? To ensure that their beloved pet will continue to receive care should something unexpected happen, it is vital to plan ahead. The following organizations will be able to help under these circumstances:
Blue Cross: www.bluecross.org.uk.
Cats Protection: www.cats.org.uk.
Cinnamon Trust: www.cinnamon.org.uk.
Dogs Trust: www.dogstrust.org.uk.
National Animal Welfare Trust: www.natw.org.uk.
Pet Fostering Service Scotland: www.pfss.org.uk.
If your elderly relative is still fairly active – visits friends, does his or her own shopping, or enjoys some hobby that gets him or her out and about – the strains and difficulties involved in caring for them may be fairly minimal. This applies particularly if your parent is moving in with you and your home lends itself to creating a granny flat, so everyone can retain some privacy and your parent can continue to enjoy maximum independence. However, this is not always possible, and in the case of an ill or very frail person far more intensive care may be required. It is important to know what help is available and how to obtain it. The many services provided by local authorities and voluntary agencies, described earlier in the chapter, apply as much to an elderly person living with a family as to one living alone. If there is nothing there that solves a particular problem you may have, it could be that one of the following organizations could help:
Age UK: www.ageuk.org.uk.
British Red Cross: www.redcross.org.uk.
Carers Trust: www.carers.org.
Independent Age: www.independentage.org.
WRVS: www.wrvs.org.uk.
Most areas have respite care facilities to enable carers to take a break from their dependants from time to time. Depending on the circumstances, this could be for just the odd day or possibly for a week or two to enable carers who need it to have a real rest. A particularly welcome aspect of respite care is that many schemes specially cater for, among others, elderly people with dementia.
Holiday breaks for carers
There are various schemes to enable those with an elderly relative to go on holiday alone or simply to enjoy a respite from their caring responsibilities. A number of local authorities run fostering schemes, on similar lines to child fostering. There may be a charge, or the service may be run on a voluntary basis (or be paid for by the local authority). Some voluntary organizations arrange holidays for older people to give relatives a break. Different charities take responsibility according to the area where you live: the Citizens Advice Bureau, volunteer centre or social services department should know whom you should approach.
Another solution is a short-stay home, which is residential accommodation variously run by local authorities, voluntary organizations or private individuals, catering specifically for elderly people. The different types of home are described under the heading ‘Residential care homes’ further on in this chapter. For information about local authority provision, ask the social services department. If, as opposed to general care, proper medical attention is necessary, you should consult your parent’s GP. Many hospitals and nursing homes offer short-stay care arrangements as a means of relieving relatives, and a doctor should be able to help organize this for you.
There are benefits and allowances available to those with responsibility for the care of an elderly person and/or to elderly people themselves. If you are caring for someone, Gov.uk is the place to turn to for the latest and widest range of online public information. It is the gateway for government advice. There is a section for carers covering support services and assessments, carer’s rights, working and caring, carer’s allowance and much more, and includes information for disabled people. See website: www.gov.uk – Disabled people.
Entitlements for carers
Home Responsibilities Protection
This is a means of protecting your state pension if you are unable to work because of the need to care for an elderly person. For further details, see under ‘The state pension’ at the start of Chapter 3, or look at the following websites: www.gov.uk; www.hmrc.gov.uk; www.nidirect.gov.uk.
If you spend at least 35 hours a week caring for someone who is getting attendance allowance or the middle or highest rate of the Disability Living Allowance care component, you may be able to claim Carer’s Allowance. You cannot get this if you are already getting the state pension or work and earn over £100 per week. See: www.gov.uk/carers-allowance.
Entitlements for elderly or disabled people
Attendance Allowance
This is paid to people aged 65 or over who are severely disabled, either mentally or physically, and have needed almost constant care for at least six months. (They may be able to get the allowance even if no one has actually given them that help.) An exception to the six months’ qualifying period is made in the case of those who are terminally ill, who can receive the allowance without having to wait. There are two rates of allowance: £53.00 or £79.15 per week. See: www.gov.uk/attendance-allowance.
Personal Independence Payment
From April 2013 a new benefit called Personal Independence Payment (PIP) began replacing Disability Living Allowance (DLA) for disabled people aged 16 to 64. As with DLA, Personal Independence Payment is designed to help disabled people live more independently and support those with the greatest need. It is made up of two parts, a Daily Living component and a Mobility component. There are two rates – standard and enhanced. For more information on the changes, and eligibility criteria, see: www.gov.uk/pip.
Cold Weather Payment
If your elderly relative is in receipt of certain benefits, he/she may be eligible for Cold Weather Payment. These are made when the local temperature is either recorded as, or forecast to be, an average of zero degrees Celsius or below over seven consecutive days. The amount paid is £25.00. Those eligible should receive it without having to claim. For more information, see website: www.gov.uk/cold-weather-payment.
This is a special annual tax-free payment of between £100 and £300 given to all households with a resident aged 60 and over. See: www.gov.uk/winter-fuel-payment.
Free off-peak bus travel
People over the age of 60 and also disabled people can travel free on any bus service in the country. See Chapter 14, section on ‘Travel and other concessions’.
Free TV licence
Anyone aged 75 or over is eligible for a free TV Licence for their main address. There are currently almost 4 million free TV Licences in force – and with some 4.9 million adults over the age of 75 living in the UK, TV Licensing is encouraging those able to claim the concession to apply online: www.tvlicensing.co.uk.
A number of charities give financial assistance to elderly people in need. Some of these may have been listed in earlier sections but are also relevant here:
Counsel and Care: www.counselandcare.org.uk.
Elizabeth Finn Care: www.elizabethfinncare.org.uk.
Guild of Aid for Gentlepeople: www.turn2us.org.uk.
Independent Age: www.independentage.org.uk.
Independent Living Fund (ILF): www.ilf.org.uk.
Motability: www.motability.co.uk.
RABI (Royal Agricultural Benevolent Institution): www.rabi.org.uk.
SSAFA Forces Help: www.ssafa.org.uk.
For many people, one of the main barriers to getting help is knowing which of the many thousands of charities to approach. Free services which help older people in genuine financial need receive the support that may be available to them from a variety of charitable sources are provided by:
Charity Search: www.charitysearch.org.uk.
Turn2Us, part of Elizabeth Finn Care: www.turn2us.org.uk.
Useful reading
For other sources of financial help, ask at your library, or search online for A Guide to Grants for Individuals in Need, published by the Directory of Social Change (www.grantsforindividuals.org.uk).
Independent Age is a support community for thousands of older people across the UK and the Republic of Ireland. Their helpful publication, Wise Guide – Life-improving advice for the over-65s, is the practical elderly person’s handbook. See: www.independentage.org.
Age UK Guides and factsheets are aimed at keeping elderly people up-to-date with home and care information. Guides are short and easy to digest giving a comprehensive overview of a subject. Factsheets are longer, more detailed and aimed at professionals. See: www.ageuk.org.uk/publications.
Elderly parents who no longer feel able to maintain a family home may decide that the time has come to move into accommodation that is smaller, easier and more economic to maintain. Some people refer to this point in their lives as ‘Managing the End Game’. Moving into purpose-designed retirement housing, with a high degree of independence and with the option to have a range of support resources as and when required, is a solution that suits increasing numbers of people. There is a wide choice available to meet individual requirements, budgets and tastes. Should their health deteriorate, they may need care in their new home, or at least the chance to call for more support if needed in the future.
Retirement living accommodation offers elderly parents the ability to maintain as much of their independence as possible, and a degree of flexibility should their needs change at any time in the future. Retirement villages are gaining in popularity and there is the added luxury of having a ready-made social network for your parents outside their front door, of people of their own age who may have similar interests. The real value of these places lies not in their facilities and activities, however attractive, but in the people who live there. Choosing the right accommodation for elderly parents is critically important, as it can make all the difference to independence, lifestyle and general wellbeing. It can also, of course, lift a great burden off families’ shoulders to know that their parents are happy and comfortable, in safe surroundings, among congenial people with the added benefit of on-the-spot help, should this be necessary.
Just to sound a note of warning: there have been recent revelations in the press about bad practice in retirement and sheltered housing management, which are little short of disgraceful (for example, adding VAT to electricity bills which already contain VAT, and paying an ‘exit fee’ to the freeholder if the property is sold, which can be as much as 5 per cent of the sale price). One suggested solution is for flat owners to club together and take over the management. Advice on this can be obtained from the Campaign Against Residential Leasehold Exploitation (www.carlex.org.uk) and the Right to Manage Federation (www.rtmf.org.uk).
Sheltered housing
There are many different types of sheltered housing schemes. Some will have a scheme manager (a warden) who lives onsite or offsite, and all should provide 24-hour emergency help through an alarm system. Each scheme usually has between 20 and 40 self-contained flats or bungalows, but there will often be communal areas. If residents require more support, extra-care sheltered housing may be available.
Sheltered housing for sale
Good developments are always sought after and can require you to join a waiting list. There are many companies offering sheltered housing for sale, with standards and facilities varying enormously. Some also provide personal care services as an adjunct to their retirement home schemes. Flats and houses are usually sold on long leases (99 years or more) for a capital sum, with a weekly or monthly service charge to cover maintenance and resident support services. Should a resident decide to move, the property can usually be sold on the open market, either through an estate agent or through the developer, provided the prospective buyer is over 55 years of age. Although the rights of sheltered housing residents have been strengthened over the years, you would nevertheless be strongly recommended to get any contract or agreement vetted by a solicitor before proceeding.
The range of prices is very wide, depending on size, location and type of property. Weekly service charges vary widely too. Additionally, there is usually an annual ground rental – and council tax is normally excluded. A particular point to watch is that the service charge tends to rise annually, sometimes well above the inflation level. Owners of sheltered accommodation have the same rights as other leaseholders, and charges can therefore be challenged by appeal to a leasehold valuation tribunal.
For further information see:
Elderly Accommodation Counsel: www.eac.org.uk.
Retirement Homesearch: www.retirementhomesearch.co.uk.
New developments are constantly under construction. Properties tend to be sold quickly soon after completion, so it pays to find out about future developments and to get on any waiting lists well in advance of a prospective purchase. Firms specializing in this type of property can be found on:
Retirement Housing Group: www.retirementhousinggroup.com.
Housing associations build sheltered housing for sale and also manage sheltered housing developments on behalf of private construction companies; see:
Anchor: www.anchor.org.uk.
National Housing Federation: www.housing.org.uk.
Rented sheltered housing
This is normally provided by local authorities, housing associations and certain benevolent societies. As with accommodation to buy, quality varies.
Local authority housing is usually only available to people who have resided in the area for some time. There is often an upper and lower age limit for admission, and prospective tenants may have to undergo a medical examination, since as a rule only those who are physically fit are accepted. Should a resident become infirm or frail, alternative accommodation will be found. Apply to the local housing or social services department or via a housing advice centre.
Housing associations supply much of the newly built sheltered housing. Both rent and service charges vary around the country. In case of need, Income Support or Housing Benefit may be obtained to help with the cost. Citizens Advice Bureau and housing departments often keep a list of local housing associations. There are hundreds to choose from; here are just a few:
Abbeyfield: www.abbeyfield.com.
Anchor: www.anchor.org.uk.
Girlings: www.girlings.co.uk.
Habinteg Housing Association: www.habinteg.org.uk.
Hanover: www.hanover.org.uk.
Jewish Community Housing Association Ltd: www.jcha.org.uk.
Southern Housing Group: www.shgroup.org.uk.
Benevolent societies
These are charitable organizations which help a particular group of people in need. Here are just a few:
Housing 21: www.housing21.co.uk.
Royal Alfred Seafarers’ Society: www.royalalfredseafarers.com.
Royal British Legion: www.ritishlegion.org.uk.
SSAFA Forces Help: www.ssafa.org.uk.
Alternative ways of buying sheltered accommodation
For those who cannot afford to buy into sheltered housing either outright or through a mortgage, there are a variety of alternative payment methods.
Shared ownership and ‘Sundowner’ schemes
Part-ownership schemes are now offered by a number of developers. Would-be residents, who must be over 55 years, part-buy or part-rent with the amount of rent varying according to the size of the initial lump sum. Residents can sell at any time, but they only recoup that percentage of the sale price that is proportionate to their original capital investment, with no allowance for any rental payments made over the intervening period.
‘Investment’ and gifted housing schemes
Some charities and housing associations operate these schemes, for which a capital sum is required, to obtain sheltered accommodation. Investment schemes work as follows. The buyer puts in the larger share of the capital, usually 50 to 80 per cent, and the housing association puts in the remainder. The buyer pays rent on the housing association’s share of the accommodation and also service charges for the communal facilities.
Gifted housing schemes differ in that an individual donates his or her property to a registered charity, in return for being housed and cared for in his or her own home. The attraction is that the owner can remain in his or her own property with none of the burden of its upkeep. However, it is advisable to consult a solicitor before signing anything, because such schemes have the big negative of reducing the value of the owner’s estate, with consequent loss for any beneficiaries. See:
Age UK: www.ageuk.org.uk/giftedhousing.
Almshouses
Most almshouses are endowed by a charity for the benefit of older people of reduced means who live locally or have a connection with a particular trade. There are now over 2,000 groups of almshouses, providing about 35,000 dwellings. Although many are of considerable age, most of them have been modernized and new ones are being built. Rents are not charged, but there will be a maintenance contribution towards upkeep and heating.
Almshouses do not provide the same security of tenure as some other tenancies, so it is advisable to check with a lawyer exactly what the beneficiary’s rights are. There is no standard way to apply for an almshouse, since each charity has its own qualifications for residence. For more information see:
Almshouse Association: www.almshouse.org.
Salvation Army homes
There are 17 care homes for elderly people in various parts of the UK, offering residential care for men and women unable to manage in their own homes, owned and operated by the Salvation Army: www.saha.org.uk.
Granny flats
A granny flat or annexe is a self-contained unit attached to a family house. A large house can be converted or extended for this purpose, but planning permission is needed. Enquire at your local authority planning department. Some councils, particularly new towns, have houses to rent with granny flats.
Extra-care schemes
A number of organizations that provide sheltered accommodation also have extra-care sheltered housing, designed for those who can no longer look after themselves without assistance. Although expensive, it is cheaper than most private care homes and often more appropriate than full-scale nursing care. A possible problem is that tenants of some of these schemes do not have security of tenure and, should they become frail, could be asked to leave if more intensive care were required. Among the housing associations that provide these facilities are Housing 21, Hanover Housing Association, Anchor and Abbeyfield (see the details listed earlier in this chapter).
Homesharing – a new idea
Homesharing is a new concept in the UK offering an alternative to residential or live-in care. It is similar to taking in a lodger, but with a focus for those in later life to be able to do this safely and maximizing the benefits for both parties. Where an elderly person has a spare room in their house, renting that room to a young person will bring them companionship, income through rent and a situation where they benefit from help around the house. For more information see My Ageing Parent: www.myageingparent.com/home-sharing.
The much-awaited reform of the long-term care system will be brought forward by a year to 2016 and the cap on payments is to be set at £72,000. From 2016 this will be the amount people must pay towards their long-term care needs, with the state stepping in to pay the rest. This will not prevent people having to sell their homes to meet the cost of their own care, experts warn, as the cap will cover only nursing, not residential costs and food. Individuals will still have to find the money for residence fees.
It is anticipated that nearly 70 per cent of men and some 85 per cent of women over the age of 65 will need care at some time. Frailty in old age is quite different from actual illness, where elderly people are entitled to receive free treatment under the National Health Service. While some older people can afford to retire in comfort and others are confident and optimistic about how they will end their days, it is very sad when relatives have to sell their loved ones’ property so that they can afford to pay for their growing care needs in their later years.
If your parents need to move into a care home, the state may help with the cost. The rules are complex and only a brief outline is given here. For more information, the local council is the point of contact. If moving into a nursing home is a continuation of NHS treatment that your parents have been having for an illness – for example he or she is discharged from hospital direct to a home – this should be paid for by the NHS. However, this is a grey area and you may have to be persistent to get their costs met in this way.
If they do not qualify for NHS continuing care, they may still qualify for some state help with care home fees, provided their needs assessment found this was the best option for them and their means are low. If their capital (savings and other assets) are above a set threshold, they will have to pay for themselves. If their capital is less, their local council may pay part or, if their capital is below the lower threshold, the full amount. Moving into a care home is a big decision, whether you are doing it yourself or for a loved one. Here are some suggestions before taking the decision:
Residential care homes (care homes registered to provide personal care)
There may come a time when it is no longer possible for an elderly person to manage without being in proper residential care. In a residential care home, sometimes known as a ‘rest home’, the accommodation usually consists of a bedroom plus communal dining rooms, lounges and gardens. All meals are provided, rooms are cleaned, and staff are at hand to give whatever help is needed. Homes are run by private individuals (or companies), voluntary organizations and local authorities. All homes must be registered with the Commission for Social Care Inspection to ensure minimum standards. An unregistered home should not be considered. It is very important that the individual should have a proper chance to visit it and ask any questions. Before reaching a final decision, it is a good idea to arrange a short stay to see whether the facilities are suitable and pleasant.
Moving to a new care home can be a highly distressing experience for an elderly person who has become attached to the staff and made friends among the other residents, so making an enquiry about long-term plans for the home is prudent. Though a move can never be totally ruled out, awareness of whether the home is likely to remain a going concern could be a deciding factor when making a choice.
Private homes
Private care homes are often converted houses, taking up to about 30 people. As more companies move into the market, the homes can be purpose-built accommodation and may include a heated swimming pool and luxury facilities. The degree of care varies. If a resident becomes increasingly infirm, a care home will normally continue to look after him or her if possible. It may, however, become necessary at some point to arrange transfer to a nursing home or hospital. Fees vary enormously.
Voluntary care homes
These are run by charities, religious bodies or other voluntary organizations. Eligibility may be determined by age, background or occupation, depending on the criteria of the managing organization. Income may be a factor, as may general fitness, and individuals may be invited to a personal interview before acceptance onto the waiting list. Priority tends to be given to those in greatest need. Homes are often in large converted houses, fees vary depending on locality.
Local authority homes
These are sometimes referred to as ‘Part III accommodation’, and admission will invariably be arranged by the social services department. If someone does not like the particular accommodation suggested, he or she can turn it down and ask the department what other offers might be available. Weekly charges vary around the country. In practice, individuals are charged only according to their means.
Nursing homes (care homes registered to provide nursing care)
Nursing homes provide medical supervision and fully qualified nurses, 24 hours a day. Most are privately run, with the remainder being supported by voluntary organizations. All nursing homes in England must be registered with the Commission for Social Care Inspection, which keeps a list of what homes are available in the area. In Wales, the inspectorate is called the Care Standards Inspectorate for Wales, and in Scotland it is called the Scottish Commission for the Regulation of Care.
Private
These homes normally accommodate between 15 and 100 patients. Depending on the part of the country, charges vary. Some fees rise depending on how much nursing is required. For information about nursing homes in the UK, contact the following:
Elderly Accommodation Counsel: www.eac.org.uk.
RNHA (Registered Nursing Home Association): www.rnha.co.uk.
UKHCA (United Kingdom Home Care Association Ltd): www.ukhca.co.uk.
Voluntary organizations
These normally have very long waiting lists, and beds are often reserved for those who have been in the charity’s care home. Voluntary organizations that run care homes include:
Careways Trust: www.carewaystrust.org.uk.
Friends of the Elderly: www.fote.org.uk.
IndependentAge: www.independentage.org.uk.
Jewish Care: www.jewishcare.org.
Free nursing care
Since October 2001, the nursing costs of being in a home have been made free to all patients. This does not include the personal care costs (eg help with bathing, dressing or eating), nor the accommodation costs; individuals will continue to be assessed for both of these under the rules described below. In Scotland, exceptionally, the personal care costs are also free. The provision of free nursing care may make only a fairly limited contribution to the cost of being in a home. Patients are assessed according to their needs and the amount of actual nursing care they require.
Financial assistance for residential and nursing home care
Under the Community Care arrangements, people needing to go into a residential or nursing home may receive help from their local authority social services department. As explained earlier, the department will make the arrangements direct with the home following its assessment procedure and will seek reimbursement from the person towards the cost, according to set means-testing rules. For further information:
Citizens Advice Bureau: www.citizensadvice.org.uk.
Elderly Accommodation Counsel: www.eac.org.uk.
Funding care
A major worry for many elderly people going into residential care is the requirement to sell their own home to cover the costs. While this may still eventually be necessary, the rules have been made slightly more flexible to allow a short breathing space for making decisions. Planning for care is essential now that we are all living longer, and there are different types of care to consider: in the home, in residential care and then in nursing care. The funding aspect is complex. The starting point is to see what the local authority can provide. Beyond that, careful planning is required so that best use is made of your parents’ income and assets. Some organizations offer advice and information for carers; see:
Care & Quality Commission: www.cqc.org.uk.
Home Instead Senior Care: www.homeinstead.co.uk.
Solicitors for the Elderly: www.solicitorsfortheelderly.com.
Further information
Key sources of information about voluntary and private homes are: the Charities Digest (available in libraries, housing aid centres and Citizens Advice Bureaux) and the Directory of Independent Hospitals and Health Services (available in libraries). The Charities Digest also includes information about hospices. Here are some other sources of advice not previously listed:
Action on Elder Abuse: www.elderabuse.org.uk.
R&RA (Relatives & Residents Association): www.relres.org.
A minority of people, as they become older, suffer from special problems that can cause great distress. Because families do not like to talk about these problems, they may be unaware of what services are available and so may be missing out on practical help and sometimes also on financial assistance.
Hypothermia
Elderly people tend to be more vulnerable to the cold. If the body drops below a certain temperature, this can be dangerous, because one of the symptoms of hypothermia is that sufferers no longer actually feel cold. Instead, they may lose their appetite and vitality and may become mentally confused. British Gas, electricity companies and the Solid Fuel Association are all willing to give advice on how heating systems can be used more efficiently and economically. It also is worth checking that elderly parents are on the correct tariff when it comes to utility bills. Some utility providers have reduced charges for elderly, vulnerable people who are in receipt of certain benefits.
Elderly and disabled people in receipt of Income Support may receive a Cold Weather Payment to help with heating costs during a particularly cold spell. Those eligible should receive the money automatically. In the event of any problem, ask at your social security office. In an emergency, such as a power cut, contact the Citizens Advice Bureau or Age UK. Every household with someone aged 60 or older will get an annual tax-free Winter Fuel Payment of between £200–£400. See website: www.gov.uk – Winter Fuel Payment.
Incontinence
Bladder or bowel problems can cause deep embarrassment to sufferers as well as inconvenience to relatives. The problem can occur in an elderly person for all sorts of reasons, and a doctor should always be consulted, as it can often be cured or at least alleviated by proper treatment. To assist with the practical problems, some local authorities operate a laundry service that collects soiled linen, sometimes several times a week. Talk to the health visitor or district nurse (at their local health centre), who will be able to advise about this and other facilities. For more information, see:
B&BF (Bladder and Bowel Foundation): www.bladderandbowelfoundation.org.
Dementia
Sometimes an elderly person can become confused or forgetful, suffer severe loss of memory or have violent mood swings and at times be abnormally aggressive. It is important to consult a doctor as soon as possible. If dementia is diagnosed, there is ongoing research into finding a cure and there are some treatments that can delay the progression of some forms of dementia.
The most common type of dementia is Alzheimer’s disease, which is usually found in people aged over 65. Approximately 24 million people worldwide have dementia, of which the majority of cases (over 60 per cent) are due to Alzheimer’s. Clinical signs are characterized by progressive cognitive deterioration, together with a decline in the ability to carry out common daily tasks, and behavioural changes. The first readily identifiable symptoms of Alzheimer’s disease are usually short-term memory loss and visual-spatial confusion. This advances to loss of familiar and well-known skills, such as recognition of objects and people.
It is important to consult your doctor as soon as you have concerns. It is also a good idea to talk to the health visitor, as he or she will know about any helpful facilities that may be available locally. The health visitor is also able to arrange appointments with other professionals, such as the community psychiatric nurse and the occupational therapist. People with dementia are still people and the Alzheimer’s Society recommends the following tips: Always treat the person with respect and dignity; be a good listener and communicator; remember that little things mean a lot.
Sources of help and support for people with dementia and their carers are:
Alzheimer Scotland: www.alzscot.org.
Alzheimer’s Society: www.alzheimers.org.uk.
Mind: www.mind.org.uk.